Cephalalgia最新文献

{"title":"Patient reported trigger, not the speed of transition to continuous headache, is associated with headache-related disability in children: Results of a cross-sectional clinic-based study.","authors":"Rachel Sehgal, Christina L Szperka, Andrew D Hershey, Carlyn Patterson Gentile","doi":"10.1177/03331024261446961","DOIUrl":"https://doi.org/10.1177/03331024261446961","url":null,"abstract":"<p><p>ObjectiveTo investigate the relationship between the evolution of continuous headache and headache-related disability in children.MethodsThis was a single site cross-sectional study using patient-entered questionnaires from children aged 6-17 who presented to neurology clinic between November 2022-May 2024 with continuous headache. Participants were categorized as sudden onset (no evolution), rapidly evolved (< 3 months), or gradually evolved (≥ 3 months) continuous headache. Analysis examined the relationship between the pattern of headache evolution and headache-related disability (PedMIDAS score), accounting for demographic, headache characteristic, and onset factors.ResultsOf 751 respondents, 42.5% reported sudden onset, 35.0% rapid evolution, and 22.5% gradual evolution to continuous headache. There was no significant difference in PedMIDAS score in children who reported sudden onset compared to children with rapid (6.9 [-2.7, 16.4], p = 0.159) or gradual evolution (10.3 [-0.8, 21.3], p = 0.068) of headache onset. Older age (3.3 per year [1.8, 4.8], p < 0.001) and patient reported trigger (17.1 [8.8, 25.5], p < 0.001) at the onset of continuous headache were both associated with greater headache-related disability, accounting for other covariates.ConclusionChildren transitioned to continuous headache quickly, consistent with prior studies. Older children and those who associated onset of continuous headache with a trigger reported higher rates of headache-related disability.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261446961"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental and psychological risk factors for migraine chronification in China: A multicenter prospective cohort study.","authors":"Longteng Ma, Linfeng Liu, Ye Ran, Xun Han, Hui Su, Mingjie Zhang, Xiaolin Wang, Xingkai An, Liang Zhang, Suiyi Xu, Wenping Gu, Shilun Zuo, Yuncheng Wu, Yan Li, Yuhu Zhang, Ming Dong, Qian Tian, Shengyuan Yu, Zhao Dong","doi":"10.1177/03331024261446614","DOIUrl":"https://doi.org/10.1177/03331024261446614","url":null,"abstract":"<p><p>BackgroundPreventing migraine chronification is a key treatment goal, yet environmental and lifestyle contributors remain understudied in Asian populations. We investigated predictors of the transition from episodic migraine (EM) to chronic migraine (CM) in a prospective Chinese clinical-based cohort.MethodsThis multicenter, prospective study involved 1642 participants with EM meeting ICHD-3 criteria. Baseline characteristics, including environmental factors and psychological scales, were captured via a Clinical Decision Support System (CDSS). Longitudinal follow-up was conducted using a web-based mini-program. Risk factors were identified using multi-variable Cox proportional hazards models, validated by LASSO and stepwise regression.ResultsDuring a median 6-month follow-up, 47 (2.9%) patients progressed to CM. Multivariable analysis identified anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7) score: Hazard Ratio (HR) 1.15, 95% Confidence Interval (CI) 1.06-1.25], baseline analgesic use frequency (HR 1.07, 95% CI 1.01-1.14), and age (HR 1.04, 95% CI 1.01-1.06) as independent risk factors. Conversely, weekly physical activity duration emerged as a significant protective factor (HR 0.66, 95% CI 0.45-0.98).ConclusionAnxiety and higher frequency of analgesic use are independent risk factors of migraine chronification in this Chinese cohort, while regular physical activity offers protection. These findings support an integrated management strategy combining psychological intervention, medication education, and exercise therapy.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261446614"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perception of headache-related disability in individuals with and without headache disorders working in a municipal government in the Tokyo Metropolitan Area.","authors":"Mamoru Shibata, Toshihiko Shimizu, Ryo Takemura, Fumihiko Sakai","doi":"10.1177/03331024261444665","DOIUrl":"https://doi.org/10.1177/03331024261444665","url":null,"abstract":"<p><p>AimThe discrepancy in headache perception between people with and without headache disorders remains poorly studied. We aimed to gain insights into the factors that determine headache perception in individuals with and without headache disorders.MethodsA questionnaire-based headache survey was administered to municipal employees in the Tokyo Metropolitan Area. The participants were divided into four groups: Group A, individuals with current headache; Group B, individuals with a history of headache; Group C, individuals without headache and without nearby individuals with headaches; and Group D, individuals without headache but with nearby individuals with headaches. In Groups A and B, migraine without aura (MO), migraine with aura (MA), probable MO (pMO), and tension-type headache (TTH) were classified according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). All participants were asked about their perceptions of headaches.ResultsThe response rate was 52.3% (1156 males and 764 females). There were 518 individuals in Group A (MO, 116; MA, 93; pMO, 95; TTH, 214) and 137 in Group B (MO, 24; MA, 24; probable MO, 29; TTH, 60). In Group A, headache severity (headache intensity, duration, and frequency), visual aura, and throbbing pain contributed to the perception of headaches as disabling. Individuals with MA were more likely to consider their headaches disabling than those with TTH (<i>p</i> = 0.0003). However, there were no differences in the proportion of respondents who perceived headaches as disabling across headache disorders in Group B. The perception of headaches as disabling was more common in individuals without headaches (Groups C and D combined) than in those with headaches (<i>p</i> < 0.0001 vs. Group A; <i>p</i> = 0.0078 vs. Group B). However, 9.7% of them responded that headaches were not a disease. In individuals without headaches, males were more likely than females to consider headaches life-threatening (<i>p</i> = 0.0037). Among females, more individuals considered headaches disabling in Group D than in Group C (<i>p</i> = 0.0306).ConclusionHeadache severity, visual aura, and throbbing pain appear to be key therapeutic targets for attenuating headache-related disability. Headache perception varied between individuals with and without headaches, and these differences were further modified by sex among those without headaches. These findings suggest that males without headaches are more likely to perceive headaches as a serious condition, whereas females without headaches appear to be influenced by the presence of nearby individuals with headaches.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261444665"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular triggers of migraine aura: A systematic review of human pharmacological provocation studies.","authors":"Zahra Hakimzadeh, Basit Ali Chaudhry, Haidar M Al-Khazali, Rune Häckert Christensen, Messoud Ashina, Håkan Ashina","doi":"10.1177/03331024261429112","DOIUrl":"https://doi.org/10.1177/03331024261429112","url":null,"abstract":"<p><p>BackgroundMigraine aura reflects transient neurological disturbances attributed to cortical spreading depolarization (CSD), yet the upstream molecular events that promote or precipitate this phenomenon remain uncertain. Human pharmacological provocation models provide a controlled approach to identifying endogenous signaling pathways capable of triggering aura and thereby clarifying their mechanistic role in migraine pathogenesis.MethodsThis systematic review was pre-registered in PROSPERO (ID: CRD420250636266) and conducted in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. PubMed and Embase were searched from database inception through January 1, 2026, without language restrictions, to identify experimental studies administering pharmacological agents to individuals with migraine with aura under controlled lab conditions. Two reviewers independently performed study selection, data extraction, and methodological assessment. Extracted variables included participant characteristics, study design, pharmacological trigger, dosing protocol, and the incidence, timing, and phenotype of provoked aura and headache. Because of substantial heterogeneity, findings were synthesized qualitatively.ResultsFourteen studies met inclusion criteria, examining seven pharmacological agents: calcitonin gene-related peptide (CGRP), levcromakalim (ATP-sensitive potassium (K_ATP) channels opener), glyceryl trinitrate (GTN), sildenafil, cilostazol, endothelin-1, and histamine. Across studies, aura induction occurred far less frequently than headache induction. CGRP provoked aura in 17 (32%) of 53 participants across three studies, with latencies ranging from 10 to 360 min. Pharmacological opening of vascular K_ATP channels by levcromakalim elicited aura in 14 (27%) of 52 participants in randomized crossover trials, with onset between 20 and 120 min. Other agents produced minimal or no aura responses.ConclusionsHuman pharmacological provocation provides a reproducible framework for dissecting molecular pathways that can trigger migraine aura. Current evidence implicates CGRP signaling and vascular ATP-sensitive potassium channel activation as the most plausible associated candidate pathways. However, standardized protocols and larger controlled studies are required to confirm these mechanisms and refine experimental models of aura biology.Trial RegistrationPROSPERO (ID: CRD420250636266).</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261429112"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal trigeminal nucleus lesions in trigeminal zoster-associated neuralgia: A retrospective cohort study on diagnostic value and prognostic factors.","authors":"Lina Wang, Yang Chen, Mingrui Li, Yin Dong, Jun-Nan Wang, Tao Sun","doi":"10.1177/03331024261435927","DOIUrl":"https://doi.org/10.1177/03331024261435927","url":null,"abstract":"<p><p>BackgroundTrigeminal zoster-associated neuralgia (TZAN) is a refractory intractable craniofacial neuropathic pain with a high risk of progressing to postherpetic neuralgia. Abnormal T2-weighted magnetic resonance imaging (MRI) hyperintensity in the spinal trigeminal nucleus (STN) has been reported in TZAN patients, but its diagnostic value, influencing factors and association with prognosis remain insufficiently explored. This study aimed to investigate the correlation between STN lesions and TZAN and identify factors affecting STN signal characteristics and TZAN therapeutic efficacy.MethodsThis retrospective cohort study included 105 TZAN patients, 105 non-TZAN normal controls (NC) and 287 classical trigeminal neuralgia (CTN) patients who underwent cranial MRI at Shandong Provincial Hospital Affiliated to Shandong First Medical University between September 2018 and March 2024. Propensity score matching (1:1, caliper = 0.1) was used to balance baseline differences between the TZAN and CTN groups. STN lesions were evaluated in a blinded manner by two radiologists, and clinical data (pain Numeric Rating Scale scores, pregabalin dosage) were collected via medical records and 6-month telephone follow-up. Multivariate logistic regression analyzed factors associated with STN hyperintensity and TZAN efficacy (pain relief ≥ 80% defined as \"excellent response\").ResultsSTN lesion detection rate was significantly higher in TZAN than in NC (62.9% vs. 1.0%, <i>p</i> < 0.001) and matched CTN (68.9% vs. 0%, <i>p</i> < 0.001), with 62.9% sensitivity, 99.0% specificity and 81.0% accuracy for TZAN diagnosis. Age (odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.006-1.116, <i>p</i> = 0.030) and subacute phase (vs. acute: OR = 32.01; vs. chronic: OR = 46.40, both <i>p</i> < 0.001) independently predicted STN hyperintensity. STN-normal patients had better short-term efficacy (discharge Numeric Rating Scale = 2 (1, 3) vs. 3 (2, 4), <i>p</i> = 0.042; excellent response rate: 38.5% vs. 19.7%, <i>p</i> = 0.036) but no long-term difference (3 and 6 months post-discharge, <i>p</i> > 0.05). Chronic phase predicted poor prognosis (vs. acute: OR = 6.55, <i>p</i> = 0.005; vs. subacute: OR = 5.39, <i>p</i> = 0.017).ConclusionsSTN lesions are highly specific for TZAN and may serve as an auxiliary diagnostic indicator. STN hyperintensity is most prominent in elderly TZAN patients in the subacute phase, potentially acting as a subacute-phase imaging marker. Early intervention in subacute TZAN may be critical for improving prognosis.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261435927"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do we facilitate individuals with recurrent headache and migraine receiving evidence-based behavioral treatment?","authors":"Paul R Martin","doi":"10.1177/03331024261439266","DOIUrl":"https://doi.org/10.1177/03331024261439266","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261439266"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and effectiveness of anti-CGRP monoclonal antibodies treatment in the prevention of cluster headache attacks: A systematic review and meta-analysis.","authors":"Lukasz Kolakowski, Marie Therese Kleinsorge, Susanne Wegener, Heiko Pohl","doi":"10.1177/03331024261434209","DOIUrl":"https://doi.org/10.1177/03331024261434209","url":null,"abstract":"<p><p>BackgroundCluster headache (CH) is one of the most severe types of pain, yet pharmacological treatment options are limited. In the present study, we aimed to systematically evaluate the effect of treatment with monoclonal antibodies (mAbs) blocking calcitonin gene-related peptide (CGRP) in the prevention of episodic cluster headache (eCH) and chronic (cCH) cluster headache.MethodsWe searched Embase, Medline, Cochrane CENTRAL and Web of Science. Included were all clinical trials, case series and single case reports that reported the effects of anti-CGRP treatment on CH. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used for abstracting data. Risk of bias was evaluated using the Risk of Bias 2 (RoB 2) tool for randomized trials and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) for non-randomized studies. The collected data from all studies were summarized using descriptive statistics. Data from randomized trials were additionally reported as odds ratio (OR) with 95% confidence interval (CI) using a random-effects meta-analysis. Given the variability in study design and the diverse formats of reported outcome data, we primarily focused on the ≥ 50% responder rate reported closest to the 4-week point following drug administration, which was consistently reported in almost all studies.ResultsFrom 734 identified records, 25 articles were included, comprising a total of 1587 patients. Meta-analysis of randomized, placebo-controlled trials suggests that anti-CGRP treatment had a statistically significant positive effect in eCH (OR = 1.65, 95% CI = 1.07-2.55, <i>p</i> = 0.02), with galcanezumab 300 mg and eptinezumab 400 mg being more effective than placebo in achieving a ≥ 50% responder rate in eCH attacks at the 4-week mark following administration. Simultaneously, a significant mean reduction in weekly attack frequency at week 4 was observed only for galcanezumab 300 mg (<i>p</i> = 0.04). Despite findings from some non-randomized trials, the meta-analysis showed no statistically significant effect in cCH (OR = 1.07, 95% CI = 0.78-1.48, <i>p</i> = 0.68).ConclusionsOur analysis revealed a beneficial effect of anti-CGRP mAbs in eCH, while no effect was observed in cCH. Despite these positive findings, the favourable results with galcanezumab and eptinezumab in eCH should be interpreted with caution due to discrepancies in the outcome data and the challenges associated with selecting endpoints in CH trials. The discrepancy between real-world data and findings from controlled trials further highlights the need for continued discussions among experts to develop more adequate methods for conducting CH trials.Trial RegistrationPROSPERO ID: CRD420250609351.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261434209"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atogepant for migraine in real-world clinical practice: Insights from a large multicentre study in a treatment-resistant population (GEMA project).","authors":"Ana Beatriz Gago-Veiga, Ana Belen Lopez-Rodriguez, Marina Sanchez Jimenez, Alvaro Iglesias Rubio, Nuria Montes, Javier Camiña Muñiz, Marta Dominguez Gallego, Carlos Calle de Miguel, Germán Latorre, Jaime Rodriguez-Vico, Alex Jaimes, Andrea Gomez Garcia, Sara Urtiaga, Marta Gonzalez Salaices, Michele Dileone, Nuria Gonzalez-García, Jesús Porta-Etessam, María-Luz Cuadrado, Alejandro Herrero San-Martin, Ángel-Luis Guerrero-Peral, Yesica Gonzalez-Osorio, Javier Casas-Limón, Antonio Sánchez-Soblechero, Alberto Lozano-Ros, Javier Díaz-De-Terán, Leonardo Portocarrero-Sánchez, Francisco-José Molina-Martínez, Sonia Santos-Lasaosa, Guillermo Martín-Ávila, Elena Riva, Iris Fernández-Lázaro","doi":"10.1177/03331024261431337","DOIUrl":"https://doi.org/10.1177/03331024261431337","url":null,"abstract":"<p><p>AimAtogepant is a novel oral calcitonin gene-related peptide (CGRP) receptor antagonist approved for migraine prevention. This study primarily evaluated its effectiveness and safety in real-world clinical practice, focusing on patients with treatment-resistant migraine, defined according to the European Headache Federation (EHF) criteria as failure of at least three classes of preventive medications, including onabotulinumtoxinA or anti-CGRP monoclonal antibodies (mAbs).MethodsThis prospective multicentre study was conducted across 15 tertiary Headache Units in Spain. Demographic and clinical data, prior preventives, monthly headache days (MHD), monthly migraine days (MMD), and adverse events (AEs) were systematically collected at baseline, 3 months (primary endpoint), and/or 6 months (secondary endpoint).ResultsA total of 513 patients were enrolled (mean age 48 years; 88% women). The 3-month analysis included 455 patients, with median MHD decreasing from 21 (IQR 15-30) to 14 (IQR 6-30) and MMD from 14 (IQR 10-20) to 8 (IQR 3-15) (both p < 0.0001). A ≥ 50% reduction was achieved by 34% (MHD) and 29% (MMD), with ≥75% responses in 16% and 13%. Adverse events were mostly mild, mainly constipation (30%) and nausea (18%), and the 3-month discontinuation rate was 11.8%. Responders had shorter migraine chronicity, less analgesic overuse, and fewer prior preventive failures. Although prior inadequate response to anti-CGRP mAbs reduced the likelihood of improvement, it did not prevent meaningful benefit. At analysis, 151 patients had reached the 6-month visit, showing further improvement (MHD 10 [IQR 5-20]; MMD 6 [IQR 4-12]) and fewer adverse events.ConclusionsAtogepant showed robust real-world effectiveness and good tolerability in a large, treatment-resistant migraine cohort, with clinically meaningful improvement at 3 months and incremental benefit in the subgroup evaluated at 6 months. Lower migraine chronicity and fewer prior preventive failures were associated with better outcomes, supporting the earlier introduction of anti-CGRP therapies in clinical practice.Trial RegistrationClinical Trials.gov NCT06241313.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261431337"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine attack incidence in relation to the post-ovulatory estrogen decline: A prospective cohort study.","authors":"Britt W H van der Arend, Sally Bakker, Daphne S van Casteren, Iris E Verhagen, Nadine Pelzer, Irene de Boer, Suzanne C Cannegieter, Antoinette MaassenVanDenBrink, Gisela M Terwindt","doi":"10.1177/03331024261436415","DOIUrl":"https://doi.org/10.1177/03331024261436415","url":null,"abstract":"<p><p>BackgroundPrevious studies suggest the perimenstrual phase increases migraine without aura risk, attributed to the decline of estrogen in this phase. However, the link to the decline of estrogen in the post-ovulatory phase remains unclear.MethodsWe conducted a longitudinal cohort study among 563 women with migraine and a regular natural menstrual cycle. Participants completed a validated e-headache diary also including menstrual cycle tracking. Of these women, 31 (who participated in our Women Hormones Attacks and Treatment (WHAT)-hormone study) performed urine luteinizing hormone (LH) surge tests during two menstrual cycles to validate the estimation of the post-ovulatory estrogen decline. The association between the post-ovulatory estrogen decline and migraine incidence was assessed using a mixed logistic model with patient as random effect, and the post-ovulatory and menstrual window as fixed effects. Secondary analyses included a case-crossover model and a self-controlled case series (SCCS) model to strengthen robustness and control for time-invariant confounders.ResultsE-diary data from 2627 menstrual cycles, including 58 from the WHAT-hormone subgroup, were analyzed. Across all three statistical models, the post-ovulatory window showed no higher incidence of migraine (with or without aura) than other menstrual cycle days (mixed logistic model: OR 0.95, 95% CI 0.89-1.02; WHAT-hormone subgroup: OR 0.68, 95% CI 0.38-1.16). The perimenstrual window had the highest migraine incidence (SCCS model with luteal phase as reference: OR 1.67, 95% CI 1.60-1.75), followed by the follicular phase (OR 1.31, 95% CI 1.26-1.37).DiscussionIn contrast to what many women with migraine believe, there is no increased incidence of migraine attacks (with or without aura) during the post-ovulatory window, but a higher incidence during the follicular phase compared to the luteal phase was confirmed.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261436415"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and tolerability of pharmacological prophylaxis in migraine patients with prior preventive treatment failure: A systematic review and network meta-analysis of randomized controlled trials.","authors":"Malahat Khalili, Faraidoon Haghdoost, Amin Liaghatdar, Kian Torabiardakani, Fatemeh Mahdian, Tariq Atkin-Jones, Tal Levit, Sara Moradi, Ehsan Hedayati, Farzaneh Ahmadi, Sahar Khademioore, Ahmad Sofi-Mahmudi, Vivek Patil, Fatemeh Mirzayeh Fashami, Soheil Mehmandoost, Rachel J Couban, Kameshwar Prasad, Seyed-Mohammad Fereshtehnejad, Behnam Sadeghirad","doi":"10.1177/03331024261441287","DOIUrl":"https://doi.org/10.1177/03331024261441287","url":null,"abstract":"<p><p>BackgroundDespite advances in migraine management, some patients fail to respond to preventive treatments for migraine. We aimed to assess the comparative effects of available pharmacological prophylaxis in adults with a treatment failure history.MethodsWe searched Medline, Embase, Cochrane Central, PsycINFO, Web of Science, and Scopus up to July 2025. Pairs of reviewers independently screened titles, abstracts, and full-text articles to identify randomized controlled trials of prophylactic pharmacological interventions that enrolled adults diagnosed with chronic or episodic migraine and a prior preventive treatment failure. We performed a frequentist random-effects network meta-analysis and used the GRADE approach to assess the certainty of evidence.ResultsWe included 18 randomized trials (7281 participants). Compared to placebo, low certainty evidence suggest fremanezumab [mean difference (MD) -3.30 (95% CI: -4.11 to -2.49)], eptinezumab [MD -3.35 (95% CI: -4.38 to -2.32)], galcanezumab [MD -2.73 (95% CI: -3.43 to -2.03)], atogepant [MD -2.30 (95% CI: -3.47 to -1.13)], and erenumab [MD -2.20 (95% CI: -2.72 to -1.68)] may be among the most effective in reducing the monthly migraine headache days. Low to moderate certainty evidence suggests that, compared with placebo, galcanezumab [relative risk (RR) 1.94 (95% CI: 1.52 to 2.48)], fremanezumab [RR 3.98 (95% CI: 2.40 to 6.59)], atogepant [RR 2.80 (95% CI: 1.73 to 4.54)], erenumab [RR 2.56 (95% CI: 2.01 to 3.26)], and eptinezumab [RR 2.35 (95% CI: 1.61 to 3.42)] may increase the likelihood of achieving a 50% response rate.ConclusionEvidence for migraine patients with prior preventive treatment failure is limited. Low- to moderate-certainty data suggest that CGRP-targeted therapies may provide some benefit and are generally tolerable, but the available evidence is driven by a few industry-sponsored trials. Additional independent, well-powered studies with longer follow-up are needed to strengthen the evidence base.Registration numberPROSPERO (CRD42024547860).</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261441287"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}